February 2011

Annual Meeting Brochure Coming Soon

This year’s Annual Meeting, Summit to Sound - Northwest Emergency Assembly is fast approaching. Make sure your calendar is marked for May 18-20, 2011. Look for your registration brochure to arrive by the end of this month. We are looking forward to seeing you in Seattle for another great meeting!

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Senate/House Supplemental Budgets: Hope for Some Health Care Services

The Senate last Friday approved its supplemental budget for the remainder of the 2009-2011 biennium (ending June 30, 2011).  Now all three supplemental budget proposals – Governor, House and Senate – are on the table and negotiations can proceed.  The longer lawmakers dally, the deeper will be the cuts necessary to get the state through the end of June.  Action this week is a must, says the Governor; otherwise she’ll have to resort to more across-the-board cuts.  

Interpreter Services – The Senate budget fully funds interpreter services through June 30, requires the work be performed by Washington State interpreters, and requires reform of how interpreter services are provided to be enacted by September 2011. Both the Governor’s and House budgets eliminate the program entirely, effective March 1.  Statewide, an estimated 4,900 patients a week use this program.

Basic Health Plan – The Governor’s budget eliminates the program entirely on March 1, 2011.  The House budget finagles a 30-day reprieve for about 38,000 of the 60,000 people covered by the program (via dropping those not eligible for federal matching funds, those under 19, over 65, or whose citizenship has not been documented).  It then eliminates the program entirely as of May 1.  The Senate budget eliminates the program for adults whose citizenship has not been verified by March 1, then freezes overall enrollment, and uses Life Science Discovery Fund money to support the program for the remainder of the biennium.

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Balance Billing Update

At the end of 2010, the WSMA and WA-ACEP filed a Writ of Mandamus with the State Supreme Court seeking to have the Washington state insurance commissioner enforce current state law. The writ asks the court to require Commissioner Mike Kreidler to enforce the statute (RCW 48.43.093) that requires health insurers pay for the emergency services of their policyholders, even when the physician providing those services is not contracted with the insurer. We are anticipating a decision back from the State Supreme Court late this month with their plans for hearing the writ.

In the meantime, House Health Care Committee Chair Eileen Cody has current legislation (HB 1561) to ban balance billing in emergency care situations. The bill is similar to provisions in the federal health care reform act (and cites two of its provisions) and its proposed enacting regulations in these respects: it applies to services provided to Medicaid and Medicare beneficiaries and patients covered by private insurance; and would pay non-contracting (or in the case of Medicare and Medicaid non-participating) physicians the highest of UCR, the median rate that health plans pay to their contracted physicians for such services, or Medicaid rates.

The bill prohibits balance billing (the federal Act does not) and empowers the insurance commissioner to write regulations to change the law if necessary (to raise or lower the payment rate/methodology).

The bill is being heard in the House Health Care & Wellness Committee on Monday, February 14, 2011 @ 1:30 pm. WA-ACEP will be there to provide testimony and oppose these measures.

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Emergency Cardiac and Stroke System Update


Thank you to all facilities that have sent in applications to participate in the Emergency Cardiac and Stroke System. We received applications from 72 hospitals:

Cardiac Level I:  29 applications 

Cardiac Level II: 28 applications

Stroke Level I: 9 applications

Stroke Level II: 25 applications

Stroke level III:  26 applications

Please note, these applications are public documents, unless a hospital indicates that a specific page in a document has confidential information (patient identifiers etc.).  

Future Application Periods

April 1, 2011 – May 31, 2011. Applications will be available for request on April 1 and due on May 31. There will be minor changes to the checklists to correct errors we found this time around, and possibly to improve their user-friendliness. If you’re going to apply in April, we suggest you wait to fill out an application until the new applications are available. The criteria and documentation won’t change so you can still work on your applications.

July 1, 2011 – August, 30, 2011, and then ever January and July as necessary. 

Implementation Phase-In Reminder

We sent out an email on January 10, 2011 informing you that we would be phasing in implementation of the ECS System rather than “going live” across the state July 1, 2011.  From the email message:  “We recognize that not all communities will be ready to implement the system locally that soon. Some communities will take longer than others due, in part, to resource availability, how far along hospitals are in developing their programs, and how far along communities are in developing local EMS plans for the new system. In light of this, the emergency cardiac and stroke system will be phased in, community by community, based on the individual community’s readiness.” 

For more information, contact Kim Kelley, Cardiac/Stroke Systems Coordinator, or 360-236-3613.


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King County Pilot: No Ambulance Diversion Policy


Beginning March 1, 2011 and ending May 31, 2011, King County will pilot a no diversion policy. During this time period, King County hospitals have been asked to discontinue the use of ambulance diversion. In support of this pilot, ambulance services will honor diversion requests ONLY when a hospital’s emergency department (ED)’s status is closed to all patients due to an internal emergency.

The Central Region EMS & Trauma Care Council has developed this pilot of No-Diversion only after thoughtful deliberation and consultation with the King County Diversion Project Steering Committee, the members of which include representatives from emergency departments, hospitals, professional associations, and emergency medical service agencies. 

For more information, contact Clark Hartley, King County Diversion Project, King County Healthcare Coalition at 206-744-7123 or


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POLST form and program revisions for 2011-12


In late 2010, the Physician Orders for Life Sustaining Treatment (POLST) form was reviewed and revised by the Washington POLST task force, a sub-committee of the Washington End of Life Consensus Coalition (WEOLCC).

One change of particular significance is the relocation of Antibiotics and Artificially Administered Nutrition sections from the front of the form to a new section on the back titled Additional Patient Preferences. This revision and others can be reviewed on the WSMA POLST webpage at (Patient Resources, Patient Brochures, POLST). The form will continue to be published on bright green paper, and earlier versions of the form, first made available in Washington state in 2001, will continue to be honored.

The 2010 revisions were approved by the WSMA and the Washington State Department of Health (DOH), the program's co-sponsors. The revision process reflects a commitment by the WSMA and DOH to review and consider revisions to the POLST program every two years. The form was last updated in December 2008.

The Physician Orders for Life-Sustaining Treatment (POLST) form and program are designed to improve the quality of care that people receive at the end of life. It is based on effective communication of patient wishes, documentation of medical orders on a brightly colored form and a promise by health care professionals to honor these wishes. 

If you have any questions about the POLST form and program, please contact Graham Short at 206.956.3633 or via email at


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The 2011 Electronic Prescribing (eRx) Incentive Program with Penalty

CMS has been offering since 2009 an incentive for eligible professionals to implement and use electronic prescribing to improve the quality, efficiency and safety of health care delivered to beneficiaries. This initiative will continue in 2011, with successful e-prescribers earning a bonus of 1% of their total allowed charges for professional services covered by the Medicare Part B Physician Fee Schedule. 

For the first time, a penalty has been introduced for 2011 that will affect Medicare payments in 2012 and 2013. Eligible professionals will be penalized if they do not report a minimum of 10 e-prescribing reporting events on a qualified system during the six-month period of Jan. 1 to June 30, 2011. A penalty of 1% will be assessed for all allowed charges for professional services covered by the Medicare Part B Physician Fee Schedule during 2012. The payment cut is estimated to be from $2,000 to $3,000 for the typical internal medicine physician. In addition, physicians that do not report a minimum of at least 25 e-prescribing reporting events between Jan. 1 and Dec. 31, 2011 will be assessed a 1.5% penalty for all Medicare allowed charges submitted in 2013. 

Physicians participating in the Medicare EHR Meaningful Use incentive program will not be eligible for the e-prescribing bonus. But, they will still have to submit at least 10 e-prescribing events by June 30, 2011 to avoid the e-prescribing penalty for 2012.

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Electronic Health Records and “Meaningful Use”

The third quarter 2010 issue of the WSMA Preceptor ( , News & Events, WSMA Reports) provided guidance on the “meaningful use” standards in the Final Rule issued by the Centers for Medicare and Medicaid Services (CMS). Practices without EHRs should watch for further developments on the temporary and final certification of EHRs as they select their own system. Practices with EHRs should ask their vendors how their systems will be brought into alignment with the new requirements and if the practice would incur additional costs as a result. If their current systems cannot be upgraded, practices may need to switch to different models. Useful resources include: 

Practices also should review the materials available from the Washington & Idaho Regional Extension Center (WIREC), offered through Qualis Health: See also the WSMA Practice Resource Center ( , in the Practice Management Operations section under Health Information Technology). For questions, contact Bob Perna at

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Six Local Hospitals Selected To Participate In National Quality Improvement Effort

The Puget Sound Health Alliance (the Alliance) announced that twelve different teams from six hospitals across the region will participate in the Aligning Forces for Quality Hospital Quality Network, an innovative, nationwide program led by the Robert Wood Johnson Foundation (RWJF), the nation’s largest philanthropy dedicated to improving the health and health care of Americans.

The AF4Q Hospital Quality Network includes three separate programs to help hospitals improve how they communicate with diverse patients, reduce the amount of time spent waiting in emergency departments (EDs), or ensure that patients who are discharged from the hospital aren’t readmitted because they missed important elements of their care.

In the Reducing Readmissions component, two area hospital teams at Overlake Hospital Medical Center and Valley General Hospital will focus on cardiac care, with the specific goal of reducing readmission rates among heart patients. The initiative will focus on cardiac care because, whether experiencing a heart attack, heart failure or other conditions, the recommended standard of care for cardiac patients is clear and accepted among medical professionals nationwide.

In the Increasing Throughput component, four area hospital teams at Multicare Allenmore Hospital, Multicare Good Samaritan Hospital, Multicare Tacoma General Hospital and Valley General Hospital will focus on making their emergency departments more efficient. The process of getting patients through the emergency department in a timely manner, either to be treated and released, or assigned a bed in an appropriate hospital unit, is known as “throughput.” Slow throughput frustrates patients and doesn’t result in the highest-quality care.  

In the Improving Language Services component, six area hospital teams at Multicare Allenmore Hospital, Multicare Good Samaritan Hospital, Overlake Hospital Medical Center, Providence St. Peter Hospital, Multicare Tacoma General Hospital and Valley General Hospital will work to improve the care experience for patients who speak or understand limited English. Hospitals will work to ensure that these patients receive their initial assessment and discharge instruction from a qualified language services provider. These two points in care are especially critical for ensuring that quality outcomes result.

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Medicaid ProviderOne: WSMA Advocacy Continues

The WSMA continues its ongoing advocacy on behalf of member physicians and their practices in addressing concerns with Washington Medicaid’s ProviderOne claims system. Working closely with Medicaid leadership, WSMA offers these recommendations:

  1. To better serve the practice community, Washington Medicaid is conducting “triage” of inquiries on claim related problems. Practices with a substantial volume of outstanding claims should make use of the Customer Service process, as Medicaid is using that mechanism to focus its efforts. Go to . Note that the first option, WEBFORM, is a secure online communication, enabling practices to include protected health information when necessary. In the “Select Topic” menu, “Claim Denial” is the preferred choice if your claims have been rejected for reasons such as provider taxonomy. IMPORTANT : In the “Comments” section, if your practice is facing substantial amounts of outstanding or denied claims, with very high adverse impact on your practice, state that in your comments! Medicaid staff will assign a high “severity” rating to your inquiry.
  2. If your claims have encountered problems with selecting the correct “Provider Taxonomy,” be sure to review the guidance available at More specific detailed guidance on “Provider Taxonomy” is available in the ProviderOne Billing and Resource Guide at Go to Appendix L - Taxonomy and ProviderOne.
  3. Avoid submitting paper claims if at all possible! Medicaid notes that paper claims take much longer to process, and typically are only successfully processed on initial submission about 10% of the time! Also, paper claims pull Medicaid staff away from resolving electronic claims, adding to the backlog.

Please keep the WSMA apprised of your claim problems! We will continue our advocacy on your behalf. Contact Bob Perna at

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CMS launches physician compare website

CMS recently launched the first phase of a searchable online physician directory for Medicare patients called Physician Compare. The site currently includes information on contacts and addresses; gender, medical specialty, the professional' education, residency or other training; and languages the professional speaks besides English. Eventually, Physician Compare will show whether physician practices have submitted data to CMS on the Physician Quality Reporting System (PQRS).

Note that the majority of the information in the Physician Compare website comes from the Provider Enrollment, Chain, and Ownership System (PECOS) system. We anticipate that CMS will provide additional guidance on the appropriate process to update your information should you continue to find inaccuracies after the upcoming PECOS update.

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CT Scans for Abdominal Pain May Reduce Hospitalizations

Despite concerns about exposing patients to excessive amounts of radiation from CT scans, a Massachusetts General Hospital study finds that such tests avoided hospitalization in nearly one in four patients who came to the ED complaining of abdominal pain.

The research focused on non-traumatic abdominal complaints because they are common reason patients seek emergency department care, yet they are often difficult for a clinician to diagnose. 

The report, published in the American Journal of Roentgenology, compared emergency department clinicians' diagnostic decisions about these patients measured by their responses to a questionnaire at two time points: before an abdominal CT was administered and after the scans were completed. 


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Calendar of Events

4th Annual Forensic Investigations
March 30 – April 1, 2011
Kansas City, MI
Meeting Brochure

Summit to Sound – NW Emergency Medicine Assembly
May 19-20, 2011
Seattle, Washington

Job Postings

EM Physician - Edmonds
Associate Site Medical Director - Sunnyside
EM Physician - WA State

NewsWatch Contributions and Suggestions

The WA-ACEP NewsWatch is your newsletter! All member contributions are welcome! We encourage you to submit articles, letters, practices tips to share in the newsletter, or send us a question you would like answered or your ideas for future articles. Email your contribution and suggestions to the WA-ACEP office at

2033 Sixth Avenue
Suite 1100
Seattle, WA 98121

(206) 441-9762 ext. 3038
1 (760) 552-0612 ext. 3038